Functional Outcomes After Critical Pathway for Inpatient Rehabilitation of Total Knee Arthroplasty
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Objective To investigate functional outcomes after the application of a critical pathway for inpatient rehabilitation of total knee arthroplasty (TKA). Methods A total of 184 patients (57 males and 127 females; average age, 71.5±5.9 years) who underwent unilateral or bilateral TKA were included. The critical pathway included early, intensive individualized rehabilitation exercises. Patients completed the following performance-based physical function tests: the stair climbing test (SCT), 6-minute walk test (6MWT), and Timed Up and Go test (TUG) as well as measurement of isometric knee flexor and extensor strength of the operated knee, gait speed, and range of knee flexion and extension. Self-reported physical function and pain were measured using the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and visual analog scale (VAS), respectively, and self-reported quality of life was measured using the EuroQoL 5 dimension (EQ-5D) questionnaire. These evaluations were performed preoperatively and at 1 month and 3 months postoperatively. Results Performance-based and self-reported physical function and quality of life measures improved non-linearly over time. Specifically, the 6WMT, TUG, gait speed, WOMAC-pain, WOMAC-function, VAS, and EQ-5D scores showed a significant improvement at 1-month post-TKA, whereas SCT, peak torque of the knee extensors and flexors, and WOMAC-stiffness scores showed gradual, but substantial, improvements over 3 months. There were between-group differences (unilateral and bilateral TKA groups) in the time course of the SCT, 6MWT, TUG, VAS, WOAMC-stiffness, and WOMAC-function results. Conclusion Patients who underwent critical pathway rehabilitation after TKA showed significant improvements in functional measurements during the first 3 months post-surgery.
Abstract
Objective To investigate functional outcomes after the application of a critical pathway for inpatient rehabilitation of total knee arthroplasty (TKA). Methods A total of 184 patients (57 males and 127 females; average age, 71.5±5.9 years) who underwent unilateral or bilateral TKA were included. The critical pathway included early, intensive individualized rehabilitation exercises. Patients completed the following performance-based physical function tests: the stair climbing test (SCT), 6-minute walk test (6MWT), and Timed Up and Go test (TUG) as well as measurement of isometric knee flexor and extensor strength of the operated knee, gait speed, and range of knee flexion and extension. Self-reported physical function and pain were measured using the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and visual analog scale (VAS), respectively, and self-reported quality of life was measured using the EuroQoL 5 dimension (EQ-5D) questionnaire. These evaluations were performed preoperatively and at 1 month and 3 months postoperatively. Results Performance-based and self-reported physical function and quality of life measures improved non-linearly over time. Specifically, the 6WMT, TUG, gait speed, WOMAC-pain, WOMAC-function, VAS, and EQ-5D scores showed a significant improvement at 1-month post-TKA, whereas SCT, peak torque of the knee extensors and flexors, and WOMAC-stiffness scores showed gradual, but substantial, improvements over 3 months. There were between-group differences (unilateral and bilateral TKA groups) in the time course of the SCT, 6MWT, TUG, VAS, WOAMC-stiffness, and WOMAC-function results. Conclusion Patients who underwent critical pathway rehabilitation after TKA showed significant improvements in functional measurements during the first 3 months post-surgery.
참고문헌 (39)
- Peat G, "Knee pain and osteoarthritis in older adults : a review of community burden and current use of primary health care", Ann Rheum Dis, 60, pp.91~97 (2001)
- Cushnaghan J, "Long-term outcome following total knee arthroplasty : a controlled longitudinal study", Ann Rheum Dis, 68, pp.642~647 (2009)
- Ethgen O, "Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature", J Bone Joint Surg Am, 86, pp.963~974 (2004)
- Xie F, "Evaluation of health outcomes in osteoarthritis patients after total knee replacement : a two-year follow-up", Health Qual Life Outcomes, 8, pp.87~ (2010)
- Kehlet H, "Fast-track knee arthroplasty: status and future challenges", Knee, 20(Suppl 1), pp.S29~S33 (2013)
- Jakobsen TL, "Early progressive strength training to enhance recovery after fast-track total knee arthroplasty: a randomized controlled trial", Arthritis Care Res (Hoboken), 66, pp.1856~1866 (2014)
- Bade MJ, "Early high-intensity rehabilitation following total knee arthroplasty improves outcomes", J Orthop Sports Phys Ther, 41, pp.932~941 (2011)
- Bade MJ, "Outcomes before and after total knee arthroplasty compared to healthy adults", J Orthop Sports Phys Ther, 40, pp.559~567 (2010)
- Walsh M, "Physical impairments and functional limitations : a comparison of individuals 1 year after total knee arthroplasty with control subjects", Phys Ther, 78, pp.248~258 (1998)
- Buhagiar MA, "Effect of inpatient rehabilitation vs a monitored home-based program on mobility in patients with total knee arthroplasty : the HIHO randomized clinical trial", JAMA, 317, pp.1037~1046 (2017)
- Ji-Ho Kang, "Determinants of Functional Outcomes Using Clinical Pathways for Rehabilitation After Hip Fracture Surgery", Annals of geriatric medicine and research, 22(1), pp.26~32 (2018), 대한노인병학회[DOI]
- Duncan CM, "A self-paired comparison of perioperative outcomes before and after implementation of a clinical pathway in patients undergoing total knee arthroplasty", Reg Anesth Pain Med, 38, pp.533~538 (2013)
- Ribinik P, "Physical and rehabilitation medicine(PRM)care pathways : "patients after total knee arthroplasty"", Ann Phys Rehabil Med, 55, pp.533~539 (2012)
- van der Sluis G, "Preoperative functional mobility as an independent determinant of inpatient functional recovery after total knee arthroplasty during three periods that coincided with changes in clinical pathways", Bone Joint J, 99, pp.211~217 (2017)
- Ayalon O, "A multimodal clinical pathway can reduce length of stay after total knee arthroplasty", HSS J, 7, pp.9~15 (2011)
- Lenssen AF, "Efficiency of immediate postoperative inpatient physical therapy following total knee arthroplasty : an RCT", BMC Musculoskelet Disord, 7, pp.71~ (2006)
- Almeida GJ, "Interrater reliability and validity of the stair ascend", descend test in subjects with total knee arthroplasty, 2010, pp.91, 932~938
- Enright PL, "The 6-min walk test : a quick measure of functional status in elderly adults", Chest, 123, pp.387~398 (2003)
- Podsiadlo D, "The timed"Up & Go" : a test of basic functional mobility for frail elderly persons", J Am Geriatr Soc, 39, pp.142~148 (1991)
- Bugane F, "Estimation of spatial-temporal gait parameters in level walking based on a single accelerometer : validation on normal subjects by standard gait analysis", Comput Methods Programs Biomed, 108, pp.129~137 (2012)
- Maffiuletti NA, "Reliability of knee extension and flexion measurements using the Con-Trex isokinetic dynamometer", Clin Physiol Funct Imaging, 27, pp.346~353 (2007)
- Thorstensson A, "Fatiguability and fibre composition of human skeletal muscle", Acta Physiol Scand, 98, pp.318~322 (1976)
- Cibere J, "Reliability of the knee examination in osteoarthritis : effect of standardization", Arthritis Rheum, 50, pp.458~468 (2004)
- Bellamy N, "Validation study of WOMAC : a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee", J Rheumatol, 15, pp.1833~1840 (1988)
- Carlsson AM, "Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale", Pain, 16, pp.87~101 (1983)
- Kim MH, "Crosscultural adaptation and validation of the Korean version of the EQ-5D in patients with rheumatic diseases", Qual Life Res, 14, pp.1401~1406 (2005)
- Benedetti MG, "Setting, clinical pathways, fast-track and rehabilitation following primary knee arthroplasty : a literature review", Open Rehabil J, 8, pp.17~24 (2015)
- Pennington JM, "Clinical pathways in total knee arthroplasty: a New Zealand experience", J Orthop Surg(Hong Kong), 11, pp.166~173 (2003)
- Judd DL, "Muscle strength loss in the lower limb after total knee arthroplasty", Am J Phys Med Rehabil, 91, pp.220~226 (2012)
- Salmon P, "Recovery from hip and knee arthroplasty : Patients’ perspective on pain, function, quality of life, and wellbeing up to 6 months postoperatively", Arch Phys Med Rehabil, 82, pp.360~366 (2001)
- Moffet H, "Effectiveness of intensive rehabilitation on functional ability and quality of life after first total knee arthroplasty : a single-blind randomized controlled trial", Arch Phys Med Rehabil, 85, pp.546~556 (2004)
- Aalund PK, "Normalized knee-extension strength or leg-press power after fast-track total knee arthroplasty : which measure is most closely associated with performance-based and self-reported function", Arch Phys Med Rehabil, 94, pp.384~390 (2013)
- Skoffer B, "Functional performance is associated with both knee extensor and flexor muscle strength in patients scheduled for total knee arthroplasty : a cross-sectional study", J Rehabil Med, 47, pp.454~459 (2015)
- Brown K, "Predictors of functional task performance among patients scheduled for total knee arthroplasty", J Strength Cond Res, 23, pp.436~443 (2009)
- Rossi MD, "Knee extensor and flexor torque characteristics before and after unilateral total knee arthroplasty", Am J Phys Med Rehabil, 85, pp.737~746 (2006)
- Mizner RL, "Early quadriceps strength loss after total knee arthroplasty. The contributions of muscle atrophy and failure of voluntary muscle activation", J Bone Joint Surg Am, 87, pp.1047~1053 (2005)
- Iwata A, "Different improvement trends in gait function and quadriceps strength early after total knee arthroplasty", J Phys Ther Sci, 31, pp.57~62 (2019)
- Valtonen AM, "Knee extensor and flexor muscle power explains stair ascension time in patients with unilateral late-stage knee osteoarthritis : a cross-sectional study", Arch Phys Med Rehabil, 96, pp.253~259 (2015)
- Huang YH, "No difference in the functional improvements between unilateral and bilateral total knee replacements", BMC Musculoskelet Disord, 19, pp.87~ (2018)